Provider Demographics
NPI:1295814747
Name:PATEL, PRADIP N (MD)
Entity Type:Individual
Prefix:DR
First Name:PRADIP
Middle Name:N
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:657 BLACKWOOD CLEMENTON RD
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021
Mailing Address - Country:US
Mailing Address - Phone:856-566-8325
Mailing Address - Fax:856-566-8326
Practice Address - Street 1:657 BLACKWOOD CLEMENTON RD
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021
Practice Address - Country:US
Practice Address - Phone:856-566-8325
Practice Address - Fax:856-566-8326
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05688800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine